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(Updated 1/5/04) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER & SAC <br /> Crystal Bay, MN 55323 <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will be sent by return mail the same day <br /> the application is received. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the pennit card is available on the job site. <br /> 5. Utility coiuiection pernlits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Deparm7ent(952-249-4600)for utility stuU as-built locations. DO NOT EXCAVATE IN ANY STREET AND <br /> DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a pemut does not grant this approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600, 24 hour notice required. <br /> JOB SITE ADDRESS: �y3� C,����l ���� �G�' <br /> Occupancy Type: �l3,esidential Commercial <br /> Owner's Name: SCo� L5`��w✓' Phone Number: �'jS�?- Y7/- �yS� <br /> Mailing Address: � � C�'�•5�.�? B�� w�� City: d��•�� Zip: S�35/ <br /> Contractor's Name: c� - o��r Phone Number: 7�3 - �%�- 35ds' <br /> Mailing Address: %Y�3� ,��� � �- City: < <'►'t���� Zip: 5 5 yY7 <br /> PERMIT TYPE ❑Comiections `�Repairs ❑Disconnect (Check One) <br /> �., <br /> SAC Charge (2003 rate $1,350.00) $ (Set Rate) <br /> Sac Charge inust accompany all sewer permit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> Municipal Sewer Connection/Disconne epair 35.00 per stub) $ <br /> pipe size inches; material d 40 air tested; cast iron <br /> Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $ <br /> pipe size inches; inaterial copper; other <br /> WATER METERS must be picked up and paid for at City Hall. <br /> Water meters must be set and sealed by Orono Water Department <br /> (952-249-4600) upon completion of ineter installation. <br /> REQUIRED minimum setbacks from drain field and septic tanks = 75' <br /> REQUIRED setback from sewer line= 20' <br /> PERMIT FEE CALCULATION <br /> l. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .50 (Minimum) <br /> The State Building Code Division Surcharge of$.50 per pernut must be <br /> included for each well,sewer and water connection pernut requested. <br /> 3. Postage & Handlin� (Only mail-in applications) $ 1.50 (Mail In Only) <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do all work in strict <br /> accordance with the ordinances of City and the regulations of the State of Minnesota, and certifies that all statements <br /> made on this application are co 1 e,true and c rrect. <br /> � � C� �] <br /> Signature of Applicant: e'`� Date: �" ( �� d/ <br />